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General NPI Number Information
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NPI Number | 1013422252
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Entity Type | Organization
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Legal Business Name | FSL ATX LLC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 2708 S LAMAR BLVD STE 100A
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City | AUSTIN
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State | TX
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Zip | 78704-3964
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Country | US
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Telephone | 737-202-4214
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 S LAMAR BLVD STE 100A
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City | AUSTIN
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State | TX
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Zip | 78704-3964
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Country | US
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Telephone | 737-202-4214
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | AMANDA MARANDA
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Credential |
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Telephone | 512-221-7419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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